Geographic disparities to transplant access exist in adults with ESRD on dialysis
Click Here to Manage Email Alerts
Key takeaways:
- Of patients referred for transplant, 31.8% in the Ohio River Valley started evaluation within 6 months.
- Factors linked to evaluation within 6 months of referral and waitlisting varied by network.
PHILADELPHIA — Geographic disparities and barriers to transplant access exist among patients with end-stage renal disease on dialysis, according to presented data.
“Efforts to address previously identified disparities in access to transplantation [may be] limited by lack of knowledge on variation and barriers and waitlisting steps,” Jade Buford, MPH, of the Regenstreif Institute, said in a presentation at the American Transplant Congress, here.
From January 2015 to December 2020, researchers examined United States Renal Data System data of 109,813 adults with incident ESRD within dialysis facilities in four regions: New England (network 1), including Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont; New York (network 2); the U.S. southeast (network 6), including Georgia, North Carolina and South Carolina; and the Ohio River Valley (network 9), including Indiana, Kentucky and Ohio.
Buford and colleagues evaluated demographic, clinical, socioeconomic and dialysis facility covariates. Overall, 58% of patients were men and 47.8% were non-Hispanic white. Median age was 60 years and 86% received dialysis at for-profit centers.
Outcomes included evaluation start within 6 months of referral among referred patients, followed through December 2022; and waitlisting within 1 year of evaluation start in patients who started evaluation and were followed through December 2021.
The goal was to determine geographic, dialysis facility and patient-level factors linked to the start of evaluation and waitlisting.
According to results, of the patients referred for transplant, 31.8% started evaluation within 6 months in network 9; while in networks 1, 2 and 6, researchers found 50%, 58.3%, and 69.9% of patients, respectively, began evaluation within 6 months of referral.
Factors linked to evaluation within 6 months of referral and waitlisting included older age, patient comorbidities and Medicaid insurance, and these varied by network.
Researchers said that patients from networks 1 and 2 were more likely to start evaluation within 6 months and be waitlisted within 1 year of beginning valuation compared with patients from network 6. Patients in network 9 had lower rates of evaluation start within 6 months but higher waitlisting within 1 year among patients who started evaluation.
“Our findings confirmed that there is geographic variation and evaluation start waitlisting and that barriers in access to these two steps vary both within and between [ESRD] networks and emphasize the importance of national data collection on pre-waitlisting steps to understand and address factors that service barriers and access,” Buford said.
Collapse
Buford J, et al. Poster 345. Presented at: American Transplant Congress; June 1-5, 2024; Philadelphia.
Read more about
Click Here to Manage Email Alerts